title: Association between hyperglycemia at admission during hospitalization for acute myocardial infarction and subsequent diabetes: insights from the veterans administration cardiac care follow-up clinical study.
abstract: OBJECTIVE
  Among patients with acute myocardial infarction (AMI) without known diabetes, hyperglycemia at admission is common and associated with worse outcomes. It may represent developing diabetes, but this association is unclear. Therefore, we examined the association between hyperglycemia (≥140 mg/dL) at admission and evidence of diabetes among patients with AMI without known diabetes within 6 months of their hospitalization.
  
  
  METHODS
  We studied a national cohort of consecutive patients with AMI without known diabetes presenting at 127 Veterans Affairs hospitals between October 2005 and March 2011. Evidence of diabetes either at discharge or in the following 6 months was ascertained using diagnostic codes, medication prescriptions, and/or elevated hemoglobin A1c. Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling.
  
  
  RESULTS
  Among 10,499 patients with AMI without known diabetes, 98% were men and 1,761 (16.8%) had hyperglycemia at admission. Within 6 months following their index hospitalization, 208 patients (11.8%) with hyperglycemia at admission had evidence of diabetes compared with 443 patients (5.1%) without hyperglycemia at admission (P < 0.001). After multivariable adjustment, hyperglycemia at admission was significantly associated with subsequent diabetes odds ratio 2.56 (95% CI 2.15-3.06). Among those with new evidence of diabetes, 41% patients (267 of 651) had a hemoglobin A1c ≥6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes.
  
  
  CONCLUSIONS
  Hyperglycemia at admission occurred in one of six patients with AMI without known diabetes and was significantly associated with new evidence of diabetes in the 6 months following hospitalization. In addition, two of five patients with evidence of diabetes were potentially unrecognized. Accordingly, diabetes-screening programs for hyperglycemic patients with AMI may be an important component of optimal care.
authors.affiliation: Corresponding author: Thomas M. Maddox, thomas.maddox@va.gov.
authors.forename: Supriya
authors.initials: S
authors.lastname: Shore
authors.forename: Joleen A
authors.initials: JA
authors.lastname: Borgerding
authors.forename: Ina
authors.initials: I
authors.lastname: Gylys-Colwell
authors.forename: Kelly
authors.initials: K
authors.lastname: McDermott
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: Maggie N
authors.initials: MN
authors.lastname: Tillquist
authors.forename: Elliott
authors.initials: E
authors.lastname: Lowy
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010343:Patient Admission; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin